title: The transverse outer preputial (TOP) island flap: an easy method to cover urethroplasties and skin defects in hypospadias repair.
abstract: OBJECTIVE
  The transverse outer preputial (TOP) island flap, a simple procedure inspired by the double-faced island flap, is proposed as a substitute for the Byars repair to provide skin coverage for most of the current reconstructive techniques for hypospadias.
  
  
  METHODS
  From 1996 to 2003, 108 consecutive children (aged 1-8 years) had a primary repair of various forms of hypospadias with different degrees of chordee; the TOP island flap was used in 66. The surgical technique is based on the use of a dorsal transverse skin flap mobilized with its own vascular pedicle from the outer foreskin, then ventrally rotated longitudinally after removing the inner part of the prepuce.
  
  
  RESULTS
  Partial necrosis of the lateral border of the flap was infrequent (<2%) and did not induce urethral complications. There was no total necrosis in the series. The rate of fistula was comparable with children operated using other techniques (8%). The cosmesis was good, with no ventral bulkiness or hypertrophic scarring.
  
  
  CONCLUSIONS
  The TOP island flap is a safe method for covering a new urethra and penile skin defects, with good cosmetic results.
authors.affiliation: Department of Visceral and Urological Pediatric Surgery, Lapeyronie Hospital, Montpellier, 371, Doyen Gaston Giraud Avenue, 34295 Montpellier Cédex 5, France. rb-galifer@chu-montpellier.fr
authors.forename: R-B
authors.initials: RB
authors.lastname: Galifer
authors.forename: N
authors.initials: N
authors.lastname: Kalfa